Provider Demographics
NPI:1538472436
Name:MUSTAFA, MALIKAH MARYAM (PT, DPT, MTC)
Entity Type:Individual
Prefix:MS
First Name:MALIKAH
Middle Name:MARYAM
Last Name:MUSTAFA
Suffix:
Gender:F
Credentials:PT, DPT, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 WALNUT VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-4672
Mailing Address - Country:US
Mailing Address - Phone:919-906-1262
Mailing Address - Fax:
Practice Address - Street 1:200 WELLMORE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9172
Practice Address - Country:US
Practice Address - Phone:803-520-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 25689225100000X
SC9603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist